心竭合并房颤的治疗策略评价课件.ppt

心衰合并房颤消融治疗的风险评估 安全性？ 再次手术比例？ 远期效果？ 心衰合并房颤消融治疗的风险评估 安全性？ 再次手术比例？ 远期效果？ 心衰合并房颤消融治疗的风险评估 安全性？ 再次手术比例？ 远期效果？ Hsu et al. NEJM 2004 Khan et al. NEJM 2008 12 mon 6 mon 房颤导管消融远期疗效 Weerasooriya, HR,2009:S55 Medi, HRS, 2009: PO05-51 Shah, JCE, 2008: 667 81.4% 74.5% 73% 末次消融术后5年随访成功率 心衰合并房颤治疗策略评价 药物治疗 节律/频率控制预后相当，长期应用胺碘酮副作用堪忧 卒中风险增加，需长期应用华法林 消融AVB＋起搏（双室） ACC/AHA/ESC 2006 IIb适应证，另外QRS不宽，从三腔起搏受益有限，III度阻滞不可逆 导管消融 难度较高的治疗措施 心脏移植 潜在治疗措施（干细胞，ＣＣＭ） HFAF:导管消融的获益与风险 心功能II-III级，临床情况稳定的HF患者，导管消融治疗是节律控制的一项可选方案 70%～80%消融后可维持稳定的窦律心律，心功能和生活质量可显著改善 导管消融总体安全，但30%～50%的患者可能需要≥2次手术，对术者经验相对有较高要求 导管消融治疗合并心衰的房颤的远期疗效及对终点事件的影响尚需进一步研究 谢 谢！ * FIGURE 2. Atrial fibrillation (AF) begets heart failure (HF), and HF begets AF. A number of mechanisms contribute to the initiation and maintenance of both AF and HF. AV atrioventricular. Framingham Heart Study Impact of Developing the Comorbid Condition on Mortality We used multivariable models to evaluate the impact of CHF on mortality in AF subjects, restricting our analyses to those who were free of CHF at the time of AF diagnosis (Table 2). The subsequent development of CHF (time-dependent variable) was associated with a multivariable-adjusted hazard ratio for mortality of 2.7 (95% CI, 1.9 to 3.7) in men and 3.1 (95% CI, 2.2 to 4.2) in women. Similarly, we examined the impact of AF on mortality in CHF subjects, restricting our analyses to those who were free of AF at the time of CHF diagnosis (Table 2). The development of subsequent AF (time-dependent variable) was associated with an adjusted hazard ratio for mortality of 1.6 (95% CI, 1.2 to 2.1) in men and 2.7 (95% CI, 2.0 to 3.6) in women. * We investigated whether the improvement in morphologic and functional variables in the group that underwent pulmonary-vein isolation occurred predominantly in patients with paroxysmal atrial fibrillation or in those with nonparoxysmal atrial fibrillation. Although the ejection fraction had increased by 3±3 percentage points at 6 months in the subgroup of pat